Incontinence Question

I haven't yet had my surgery, but it is scheduled for early March. I'm curious and confused about Kegels and incontinence. After a radical prostatectomy, do you stay continent by essentially doing a Kegel contraction most of the time, or does continence feel the same as it did prior to surgery? In other words, do you have to continually "squeeze" to hold the urine in, or does the remaining sphincter ultimately work "naturally" and unconsciously?

Thanks to all of you. I have been more of a lurker than a poster, but I have learned a lot and wish you all the best.

Thanks James. I have an especially large prostate like yours and I understand that could make things worse. It looks like that wasn't an issue with you and it gives me some encouragement.

I am with James C. At first and I tried not to think about it and found myself doing a little too much squirting. When lying down or sitting there was absolutely no thought and dryness was present, but upon standing I found myself concentrating on holding the muscles especially when getting up from a chair. This was also true when exercising, picking up things, or longer walks. As time has gone on and gradual improvement has been made the thoughts on squeezing have become less and less. I think the squeezing goes on but becomes more in the subconscious.

As far as the feeling down there, I cannot tell the difference really post to pre surgery other than the tendency to occasionally and usually unexpectedly release small quantities of fluid. The valve system is just not quite as tight or certain as before.

Sam, leaking during intercourse or foreplay is a real possibility and several guys have that problem, including me at times. Some of the guys use condoms during sex, some have understanding wives who are not put off by sterile urine leaking inside them and some who wear very small penis rings during sex. Those rings cut off the flow or urine but allow for sex as usual. You don't have ejaculations now anyway, so there's no problem with cutting off the flow. Leaking during sex is a little secret that most guys don't anticipate or have been warned about. When I am approaching orgasm, I have learned/trained to clamp down on the muscles to hold the urine in. Most times it works, but when it doesn't it's no big deal for us. Others may be different. Urinating just before sex or entry may help some.

David, I am thinking of making a list of things we can get blindsided by or not know to ask about when getting the RRP surgery, both open and robotic.

MichGuy,

I'm 3 1/2 weeks post-op. I don't have to think about squeezing a kegel to hold it in but I still need a pad a day. At first a sneeze, a cough, or just standing up from sitting caused a squirt or leakage. Now only an unusual strain or if I get real tired (or have an extra cocktail) will cause leakage. No problem in knowing when to go.

MichGuy

For me after catheter was removed it was like I felt sometimes like I had to pee or that something was coming out but it really wasn't. You are very self conscious at first for the few days to a week for sure and feel like you can't help but to try to hold it all the time. After awhile it becomes natural and you relax and don't think about it.

As my doctor put it, the sphincter left intact that we use was always a voluntary response by your body that you have to relearn.

I was lucky and thought urine would just always be pouring out but it just never happened. Possibly a result of tighter muscle control prior to surgery - I don't know. I have always done sit ups and it's all connected down there somehow.

DJ, kind of glad I wasnt the only one with that confusion. I stay up late most nights, midnight to 1 AM, thats my normal even presurgery, so I go once last time, and then dont wake up or go again till 7 to 730 in the AM.

My catheter was removed 10 days following surgery and I had no control whatsoever. Fifteen hours later I was in the ER because I went into retention. Catheter was reinserted for another three weeks and then removed on 12/22/08 without any problems. My incontinence was a constant flow, whether sitting, standing, walking, or lying down, requiring diapers 24 hours a day. I was doing Kegels, but they didn't seem to be helping.

about a week after the catheter came out something just clicked. I found myself running to the men's room every 30-45 minutes. I was holding my water and I wasn't even THINKING about IT. Over the next two weeks I did not have a single accident during the day and only very minor leaks. That gave me the confidence to switch to a male guard. My pit stops are much less frequent now that my bladder has stretched back out. My day time pad has been dry for 2 weeks now.

There are a few things that are different though since the surgery. When I sense that I need to go I can only put it off for a few minutes, but I no longer have a shy bladder and like Paul1959 I pee like a race horse (huge stream). I've also found that my bowels have become very regular, but once again when I sense that I need to go I can only put it off for a few minutes.

Interesting side note... I had a 14 year history of a neurogenic bladder, mixed incontinence, and adult diapers going into the surgery, so my expectation was that I would lose what little control I had left. I did not expect that the surgery would cause the bladder to retrain itself, giving me back control. Just remember that every man in this forum has had a completely unique experience in their healing, and so will you.

Shawn